Coexisting Postural Orthostatic Tachycardia Syndrome on Autonomic Reflex Testing in Functional Neurologic Disorder.
Sushmita Das, Sri Rama Narayana Yerraballa, Priyanka Shekhawat
✦ AI-curated · Sources linked
Case in brief
An 18-year-old woman with a prior diagnosis of functional neurological disorder (FND) presented with fluctuating lower-extremity weakness, gait disturbance, and recurrent drop attacks, alongside persistent orthostatic intolerance. Neurological examination confirmed functional weakness, while autonomic testing revealed elevated COMPASS-31 scores and sustained sinus tachycardia during head-up tilt table testing. Over several months, her functional status improved significantly with multidisciplinary care.
What made this case unusual
The coexistence of postural orthostatic tachycardia syndrome (POTS) in a patient previously diagnosed with FND, highlighting the potential for diagnostic overshadowing.
Diagnostic / clinical pearl
Clinicians should consider the possibility of coexisting physiological disorders, such as POTS, in patients with a prior diagnosis of functional neurological disorder who present with persistent orthostatic symptoms.
Why it matters
This case underscores the need for systematic autonomic evaluation in patients with FND to avoid overlooking significant comorbidities that may impact management and recovery.